1. Field of the Invention
This invention relates to devices for placing sutures to close incisions and more particularly relates to a device and method to efficiently close small incisions used in laparascopic surgery.
2. Background Information
Laparascopic surgical procedures generally use small incisions some 5 to 16 millimeters in length for placement of a cannula and trocar used in laparascopic surgical procedures such as cholecystectomy, hemiorrhaphy, Nissen, hysterectomy, colectomy, etc. One method used to close such incisions is by simple surface skin or facial closures. However, a not infrequent problem with this and other methods is that the closures are not affective enough and lead to complications such as hernias and bowel strangulations.
Another method used to close such incisions is by a tedious procedure that requires a surgeon to laparascopically grasp a suture from a closure insertion device after placement through the abdominal wall. The closure insertion device is then withdrawn and then reinserted through the abdominal wall on the opposite side of the trocar site incision. The surgeon must then reinsert the needle into the closure insertion device and then withdraw it creating a loop around the trocar site incision. The tedious part of the process is the need to reinsert the suture into the closed insertion device which sometimes requires a surgeon to xe2x80x9cwork backwardsxe2x80x9d depending on the camera location.
Thus there is a need for a simple and preferably disposable device for closure of trocar site incisions used in laparascopic surgical procedures described above. A device that could quickly, efficiently and atraumatically insert sutures to close a laparascopic incision would be advantageous.
There is an existing device called a Brown/Mueller Fastener described in U.S. Pat. No. Re. 34,021 of Peter R. Mueller et al, that is designed to insert a T-bar fastener through the abdominal wall. This device has a needle with a slot in the end for receiving a metal T-bar with a single short suture extending through the slot along the outside of the needle. The needle with the loaded metal T-bar and short suture is then inserted through the abdominal wall. The metal T-bar and attached suture is then extruded from the needle allowing the metal T-bar to fasten the suture inside the abdomen. This device is currently used for securing a portion of an intestine to the abdominal wall for placement of feeding tubes. A disadvantage of this device is that it allows placement of only a single suture which must be securely held by the surgeon while the needle is piercing the abdomen.
It is therefore one object of the present invention to provide laparascopic insertion/closure device that can quickly and efficiently place multiple T-bar sutures on opposite sides of a trocar site incision to close the wound.
Another object of the present invention is to provide a laparascopic incision closure device that can store multiple T-bar sutures inside a housing.
Still another object of the present invention is to provide a laparascopic incision closure device having an ejection mechanism for firing and ejecting one T-bar suture at a time. dr
The purpose of the present invention is to provide a laparascopic incision closure device and method for quickly and efficiently placing multiple T-bar sutures on opposite sides of a trocar site incision to close defects left by the incision.
The laparascopic incision closure device is particularly designed and adapted to close small incision, used in laparascopic surgery on such as cholescystectomy, herniorrhaphy, Nissen, Hysterectomy, colectomy, and the like. These incisions are generally 5 to 16 millimeters in length and allow instruments to be passed through the abdominal wall through a cannula. The defect left by these incision must be closed to prevent development of complications such as hernia and bowel strangulation.
In the preferred embodiment of the laparascopic incision closure device of this invention, the device consists of a housing having a handpiece that is biased by a spring member toward an unactivated position. The handpiece carries a drive rack that rotates a pinion in one direction when the handpiece is compressed and in the other direction when the handpiece is released and returns toward the unactivated position. A needle having a longitudinal axis and a longitudinal bore forming a bounded passageway through the needle, is carried by the housing. To feed T-bar sutures into the longitudinal bore for ejection through the bore and out of the needle distal tip, a spline member having an axis of elongation spaced radially in relationship to the longitudinal axis of the longitudinal bore which extends through the needle, is moveably mounted to the housing; a plurality of axially spaced T-bar sutures are detachably carried by the spline member by respective mounting tabs extending from each T-bar portion. To feed a T-bar portion into the longitudinal bore, a ratchet mechanism activated by sufficient return movement of the handpiece engages a mounting tab and indexes the suture spline to feed a T-bar portion into the longitudinal bore. By compressing the handpiece from its unactivated position, a wire push-rod member engages the T-bar portion so as to advance it and its trailing suture portion through the longitudinal bore and to sever the T-bar portion mounting tab from the spline member. When the handpiece reaches its limit of travel position, the T-bar portion is ejected through the radial distal opening in the needle. With the handpiece held in the limit position, the needle is withdrawn through the tissue and the trailing suture strand portion passes through the radial distal opening of the needle. By releasing the handpiece, the wire push-rod is retracted, the ratchet indexed, and the spline member is advanced to feed another T-bar portion into the longitudinal bore.
In another embodiment, the laparascopic incision closure device is comprised of an ejector housing having finger gripping holes and a needle extending from the end of the housing. The needle is preferably about 18 millimeters. Multiple T-bar sutures are stored in the needle with the suture extending up the needle and stored inside the ejector housing. In one embodiment the sutures extend into the housing and wrap around inside the rings forming finger gripping holes.
A plunger extending through the needle ejects T-bar sutures one at a time by activation of a trigger that fires and releases a plunger shaft pushed forward by the thumb placed in a thumb ring on the end of the shaft. When loaded the plunger shaft position is locked by a spring operated pin. The pin engages a slot in the side of the plunger shaft.
The trigger is preferably mounted in the housing below the rings forming the finger handles. The trigger has a tapered end forming a cam that engages a shoulder on the locking trigger pin to dislodge the pin from the plunger shaft allowing the plunger shaft to move forward pushing the plunger along the needle to eject a T-bar suture. A second socket along the plunger shaft locks the trigger with the plunger in position for ejecting another T-bar suture from the needle.
To place a second T-bar suture the locking pin is again released from the second socket by operation of the trigger allowing the plunger shaft to be retracted by the thumb in the thumb ring. This positions a second T-bar suture for ejection from the needle. As the plunger shaft is retracted the locking plunger and pin slide along a groove in the trigger shaft and again lock in a first socket ready for repeat operation.
In a less preferred embodiment the trigger is a rotatable lever or button above the finger rings in the ejector housing having a pointed end engages detents in the plunger shaft. The trigger is pivotally mounted on a pin and has a tip that is biased into engagement with detents on the plunger shaft by a spring. To operate the device the trigger button is pushed or tilted toward the ejector housing releasing the tip from a plunger shaft detent allowing the plunger shaft to advance advancing the plunger to eject a T-bar suture. A second detent in the trigger shaft re-engages the trigger when the T-bar suture is ejected. To place another suture the trigger button is again operated allowing the plunger shaft to be further advanced by the thumb ring positioning the suture plunger in the needle for ejection of a second T-bar suture.
The laparascopic incision closure device is preferably constructed of a disposable plastic material with multiple T-bar sutures carried on a suture spline that has spline mount tabs detachably connecting the T-bar portion of the T-bar sutures to the suture spline. A suture strand portion extends from the T-Bar portion and has a free end that trails the T-bar portion where the T-Bar suture is advanced through a longitudinal bore in the needle.
Preferably the sutures are placed with a cannula in place in a laparascopic incision. The sutures are also preferably made of an absorbable material such as an xe2x80x9cO-Vicrylxe2x80x9d suture attached to an absorbable T-bar made of material similar to that used in xe2x80x9cAbsalock Clipsxe2x80x9d such as polydioxone. The T-bar sutures are placed on either side of a trocar incision under direct visualization. Preferably, the laparascopic incision closure device needle is inserted through the fascia on one side of the wound with the cannula still in place. The needle is then withdrawn leaving the T-bar suture in place through the fascia. The needle is then inserted through the fascia of the opposite side of the wound and a second T-bar suture ejected. With the cannula removed the sutures then can be tied over the fascia defect externally. Thus all surgeon needs to do is insert T-bar sutures through the fascia on either side of the cannula in the trocar site then tie the two sutures over the defect. The closure is very simple and cost effective.